Journal Article

Additional MRI for initial M-staging in pancreatic cancer: a cost-effectiveness analysis

Felix G. Gassert, Sebastian Ziegelmayer, Marcus R. Makowski, Matthias F. Froelich, Johannes Rübenthaler, Johann Rink, Johanna Luitjens, Florian T. Gassert, Fabian Tollens

2022

Overview

Objective Pancreatic cancer is portrayed to become the second leading cause of cancer-related death within the next years. Potentially complicating surgical resection emphasizes the importance of an accurate TNM classification. In particular, the failure to detect features for non-resectability has profound consequences on patient outcomes and economic costs due to incorrect indication for resection. In the detection of liver metastases, contrast-enhanced MRI showed high sensitivity and specificity; however, the cost-effectiveness compared to the standard of care imaging remains unclear. The aim of this study was to analyze whether additional MRI of the liver is a cost-effective approach compared to routinely acquired contrast-enhanced computed tomography (CE-CT) in the initial staging of pancreatic cancer. Methods A decision model based on Markov simulation was developed to estimate the quality-adjusted life-years (QALYs) and lifetime costs of the diagnostic modalities. Model input parameters were assessed based on evidence from recent literature. The willingness-to-pay (WTP) was set to $100,000/QALY. To evaluate model uncertainty, deterministic and probabilistic sensitivity analyses were performed. Results In the base-case analysis, the model yielded a total cost of $185,597 and an effectiveness of 2.347 QALYs for CE-MR/CT and $187,601 and 2.337 QALYs for CE-CT respectively. With a net monetary benefit (NMB) of $49,133, CE-MR/CT is shown to be dominant over CE-CT with a NMB of $46,117. Deterministic and probabilistic survival analysis showed model robustness for varying input parameters. Conclusion Based on our results, combined CE-MR/CT can be regarded as a cost-effective imaging strategy for the staging of pancreatic cancer. Key Points • Additional MRI of the liver for initial staging of pancreatic cancer results in lower total costs and higher effectiveness. • The economic model showed high robustness for varying input parameters.

• Publisher: Springer Science and Business Media LLC,Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Cancer / Computed tomography / Cost analysis / Cost-Benefit Analysis / Diagnostic Radiology / Economic analysis / Economic impact / Economic models / Economics / Gastrointestinal / Gastrointestinal ; Pancreatic neoplasms ; Cost-effectiveness ; Cancer staging ; Magnetic resonance imaging ; Multidetector computed tomography / Humans / Imaging / Internal Medicine / Interventional Radiology / Liver / Magnetic Resonance Imaging / Magnetic Resonance Imaging - methods / Mathematical models / Medical imaging / Medicine / Medicine & Public Health / Metastases / Neuroradiology / Pancreatic cancer / Pancreatic Neoplasms / Pancreatic Neoplasms - diagnostic imaging / Parameters / Probability theory / Quality-Adjusted Life Years / Radiology / Robustness / Sensitivity analysis / Survival analysis / Tomography, X-Ray Computed / Tomography, X-Ray Computed [MeSH] ; Multidetector computed tomography ; Quality-Adjusted Life Years [MeSH] ; Cost-Benefit Analysis [MeSH] ; Cancer staging ; Cost-effectiveness ; Gastrointestinal ; Humans [MeSH] ; Pancreatic neoplasms ; Magnetic resonance imaging ; Magnetic Resonance Imaging/methods [MeSH] ; Pancreatic Neoplasms/diagnostic imaging [MeSH] / Ultrasound